Provider Demographics
NPI:1871017731
Name:COMPANY, MATTHEW EUGENE
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EUGENE
Last Name:COMPANY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8232 SAINT PETERS CHURCH RD NW
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8529
Mailing Address - Country:US
Mailing Address - Phone:330-418-7027
Mailing Address - Fax:
Practice Address - Street 1:3129 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3756
Practice Address - Country:US
Practice Address - Phone:330-837-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist